Program A: Medical Vendor Administration

PROGRAM DESCRIPTION

The mission of the Medical Vendor Administration Program is to develop and implement the administrative and programmatic procedures to provide quality health care to all qualified Louisiana residents enrolled in the Medicaid Program.

The goal of Medical Vendor Administration Program is to administer the Medicaid program to ensure that it operates in an efficient and effective manner according to federal and state statutes, rules and regulations.

The Medical Vendor Administration Program includes the following activities: Medicaid Management Information System, Medicaid Eligibility Determinations, Program Integrity, and Health Standards.

2. In FY 1998-99, the Medical Vendor Administration Program, through the Medicaid Eligibility Determinations activity, will provide Medicaid Eligibility Determinations and administer the program within federal regulations, by processing 97% of applications timely.

1 The federal Medically Needy Program is reinstated and the potential of having to do aggressive outreach to eligibles exists.

3. In FY 1998-99, the Medical Vendor Administration Program, through the Program Integrity activity, will ensure that expenditures for Medicaid services are appropriate.

1 DHH has hired additional Program Integrity and legal staff, and as a result, collections increased to $40 million, including $30 million from Psychiatric Hospitals. As these new auditors are hired and working on cases, the Department expects the compliance rate to improve.

4. In FY 1998-99, the Medical Vendor Administration Program, through the Health Standards activity, will enforce licensing standards and certification requirements through licensing, surveying, and certification of health care providers.

2 Out of compliance: Facilities that are determined not to meet conditions of participation, have substandard quality of care or have a limited capacity to furnish services required by Medicare/Medicaid.

3 Sanction: Includes civil monetary penalties, denial of payment for new admissions, state monitoring, directed plans of correction.

RESOURCE ALLOCATION FOR THE PROGRAM

SOURCE OF FUNDING

This program is funded with general fund, fees and self-generated revenues, and federal funds. Fees and self-generated revenue are derived from miscellaneous collections, such as document copies. Federal funds represent the federal share of the cost to administer the Medicaid program. The federal share varies by type of activity, but averages about 60% of the total Medicaid administrative cost.

ANALYSIS OF RECOMMENDATION

GENERAL FUND

TOTAL

T.O.

DESCRIPTION

$34,068,049

$94,192,622

1,121

ACT 18 FISCAL YEAR 1997-1998

BA-7 TRANSACTIONS:

None

$34,068,049

$94,192,622

1,121

EXISTING OPERATING BUDGET - December 10, 1997

($401,691)

($803,381)

0

Non-recurring Adjustment(s) for the costs of a non-emergency medical transportation scheduling contract in the New Orleans area as this function will be performed by State Staff in FY 1998-'99.

($17,500)

($35,500)

0

Non-recurring Adjustment(s) for the contract for the investigation of complaints against nursing homes

($150,000)

($300,000)

0

Non-recurring Adjustment(s) for the Medicare buy-in program computer system up-grade to reflect the completion of the contract

($62,500)

($125,000)

0

Non-recurring Adjustment(s) for the costs of independent assessment waivers, the scope of which varies every other year

Fund an increase in the scope of audits of acute care hospitals, federally qualified and rural health clinics, and mental health and substance abuse outpatient clinics

$12,500

$25,000

0

Fund the cost of expert testimony and consultation for court cases brought as a result of increased fraud and abuse detection efforts by the department

($9,273)

($18,545)

0

Reduce funding for student labor to the level student employment projected by the department for FY 1998-'99

$1,760,000

$3,520,000

0

Fund the cost of enhancements to the computer system for the Welfare Information System to make year 2000 compliant

$0

$1,613,348

2

Provide funding and positions to replace the positions transferred to the Office of Mental Health

$340,462

$680,923

0

Transfer funding for the Bock nursing home resident assessment contract from management and finance to this appropriation, and substitute matching federal funds for one-half of the general fund

$41,289,385

$103,862,469

1,121

TOTAL RECOMMENDED

$7,221,336

$9,669,847

0

DIFFERENCE (TOTAL RECOMMENDED AND EXISTING OPERATING BUDGET)

The total means of financing for this program is recommended at 110.3% of the existing operating budget. It represents 97.2% of the total request ($106,918,939) for this program.

Most of the difference between the existing operating budget and the total amount recommended can be accounted for by the addition of $4.4 million ($2.2 million general fund) for an increase in the fiscal intermediary contract, including an increase in the scope of services provided by the contractor in processing claims for payment of providers of covered medical services for Medicaid eligible patients. In addition, $3.5 million ($1.8 million general fund) was provided to upgrade the Welfare information computer system for year 2000 compliance, and $690,923 ($340,462 general fund) was increased by the transfer of the Bock contract to screen nursing home residents for appropriateness of placement from the Office of the Secretary in order to access federal financial participation in the cost of the contract.